For Members: 2018 Health Renewal FAQs

THE ARGUS GROUP|04 APRIL 2016

Every year, Argus reviews its current health policies and makes revisions needed to keep up with Bermuda’s rapidly changing healthcare system to ensure that Argus members have top rate quality coverage. This year’s renewals are effective as of July 1, 2018 and this guide will help to answer your questions regarding this process.

Did you Know?2018 Frequently Asked Questions on Health benefits for members

The Bermuda Health Council

1. What is the role of the Bermuda Health Council?

The Bermuda Health Council Act was introduced to the House of Assembly in 2004 to establish the Bermuda Health Council with specific responsibility to regulate, coordinate and enhance the delivery of health services. For further information, visit www.bhec.bm.

Standard Health Benefit

2. What is the Standard Health Benefit?

The minimum level of health insurance in Bermuda is called the Standard Health Benefit (“SHB”). By law, all employers and self-employed persons are required to provide this cover for their employees and non-working spouses and to cover at least half of the cost of this insurance. The SHB covers inpatient hospital care, services provided in the emergency and outpatient departments including diagnostic and laboratory tests, the ambulance service, care at Agape House and the Mid-Atlantic Wellness Institute, and specified services in the home and at approved facilities. Most employers provide benefits well in excess of the minimum for both employees and their insured dependents.

3. What are the Standard Health Benefit changes and when do the changes come into effect?

We anticipate the following SHB changes will take effect on July 1, 2018:

Increases in fees for MRI and CT scans, and dental and physicians’ services performed in the local hospital

New benefits include coverage for medical nutritional therapy under the Home Medical Services benefit, 3D mammography and multiple views of select x-rays.

4. What is the Standard Premium Rate and will there be any changes?

Each year, the Government sets the Standard Premium Rate (“SPR”), which is the maximum premium that insurance companies may charge for the SHB.

Effective July 1, 2018 (typically May 1), Government has confirmed that the SPR will be increased from $334.00 to $355.31 per adult, per month; and the breakdown of premium associated with the Health Insurance Act benefits (“HI”) and the Mutual Reinsurance Fund (“MRF”) tax will be altered. The HI portion of the SPR will be reduced from $242.43 to $253.34, while the MRF levy collected by insurers for and on behalf of and remitted to Government will increase again this year from $91.57 to $101.97 per month per employee and non-working spouse.

Medical Inflation

5. What is medical inflation?

Health care premium increases are attributed largely to the rising cost of health care, which is referred to as medical inflation. Healthcare costs increase for a number of reasons, including:

increases in the price of general goods and services that affect all of us, including medical providers, who have to pay more for medical equipment, staff expenses, rent, electricity etc.

new and emerging technologies and treatment, such as stem cell transplants and biologic medications

the high incidence of chronic illness

6. Why are new medical therapies and drugs increasing the cost of healthcare?

Stem cell transplants and biologics, in particular, have gained traction over the past several years and are now being successfully utilised to treat a variety of diseases and conditions that include leukemia, multiple sclerosis and pulmonary disease. Deploying new advancements to market is a costly exercise, in the short term, for our insureds and overall book of business. We are however committed to supporting innovative technologies and emerging therapies that require upfront investment but ultimately improve the long-term health status of our clients and decrease the continuing surge in healthcare costs.

Mutual Reinsurance Fund

7. What is the Mutual Reinsurance Fund?

In the past, the MRF served as a risk equalisation scheme to spread risks across the entire working population; i.e., everyone in Bermuda shared equally in the cost instead of just a few. Cover for high dollar claims, including dialysis, kidney transplants and anti-rejection drugs, that were removed from the MRF in 2014, was returned in June 2017 to help spread the risk and reduce claims costs for private insurers. A portion of funds collected for the MRF is allocated to subsidise the cost of the government administered Health Insurance Plan (“HIP”) and FutureCare programmes; the Bermuda Hospitals Board (“BHB”) operational and administrative costs; and the funding of the Bermuda Health Council.

Health Insurance

8. How does health insurance work?

Health insurance is a contract between an employer and the insurance company that is renewed on an annual basis. It is not like a bank account where one puts money in and hopes to see a return after several years. It is a protection against the risk of not being able to pay for very expensive medical treatment, if needed. Health insurance is a means of exchanging such large and unpredictable costs for the small and predictable expense of a monthly insurance premium. Insurance is a pooling method, whereby many people contribute to the pool and, at any given time, only a few people draw from the pool.

9. Why has the renewal date changed from May 1 to July 1?

The Bermuda Government deferred the changes in legislated benefits and premiums to July 1 of this year. Argus changed its annual health renewal to July 1 to align with the changes in legislated benefits and premiums.

10. How will the change in renewal date affect me?

Benefit changes and adjustments in renewal premium and payroll deductions will take place on July 1 this year, versus May 1.Your policy year remained unchanged and the policy year benefits and maximums reverted to zero on May 1. For the months of May and June, claims will be paid in accordance with the 2017 benefit amounts. Effective July 1, claims will be paid per the 2018 benefit schedule. For example: claims for annual eye and health exams obtained in May and June will be considered under the 2018 policy year but paid at the 2017 benefit amount.

11. What is Argus doing to reduce the escalating costs of healthcare?

We are driving for increased efficiencies to keep our internal costs as low as possible

We are lobbying for change and sustainability, advocating for the best quality care at the lowest prices

We are working to prevent and manage chronic disease via our Thrive. Population Health and Nurse Case Management programmes

Wellness Tools

12. What tools are available to help me better manage my healthcare?

As Argus continues to advocate for sustainable solutions to Bermuda’s healthcare challenges, we encourage you to take full advantage of the broad range of Thrive. tools and resources, which are available at no additional cost.

The following is a list of the Thrive. resources available:

Thrive. Case ManagementThrive. In collaboration with Johns Hopkins Medicine International and local healthcare providers, Thrive. Case Management supports members with chronic conditions with comprehensive plans, guidance and encouragement to improve their self-management skills and health status.

Get Up & Thrive.Get Up & Thrive. is our online activity-based platform available year-round, via any mobile device. Powered by Virgin Pulse, this social wellness programme drives engagement by connecting people to physical and wellness challenges and rewards to maximise well-being.

Health Risk Assessment (HRA)

Our Health Risk Assessment (HRA) online questionnaire, designed to evaluate health history and lifestyle habits, will assist with determining your overall health status and the potential risks for certain chronic diseases or illnesses.

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Thrive is intended to complement rather than substitute for proper medical advice or treatment. *Johns Hopkins Medicine International (JHI) provides consultation and advice on the Case Management Nurse Advocate program.